[Laparoscopic treatment of abdominal wall hernias: prosthesis material comparison]. / Trattamento laparoscopico delle ernie della parete addominale: confronto fra i materiali protesici.

Hernia is due to abdominal wall weakening. This allows the contents of the abdomen to protrude from normal boundaries. Hernias are repaired by implanting a sterile surgical mesh to strengthen the weakened abdominal wall. Aim of this study is to compare the results obtained by bard Composix® L/P mesh or Dualmesh Plus Gore® implanting. The mesh has various beneficial characteristics. It is a reinforcing material for the abdominal wall, even when in the direct contact with the intestinal tract does not cause adhsion problems. The use of biocompatible materials is necessary in laparoscopic hernia repair. e-PTFE prosthesis and Dual Mesh® were the first to be used for laparoscopic treatment of the abdominal wall defects. These prosthesis are the result of many improvements, actually they are 1-mm thick and the two surfaces have different characteristics. Compound meshes are composed by e-PTFE and polypropylene with different percentage of the two materials and methods of interactions. The incidence of early complications were poor in relation to both types of implants, only seroma cases e-PTFE treated showed a prevalence of complication, in agreement with literature. About relapses in our experience we found that e-PTFE cases were predominantly. Dual Mesh® has better adaptability than Bard Composix®, which allows easier placement of the prosthesis as well as a better adaptation to the wall surface. The Bard Composix®, thanks to rigidity due to the polypropylene component has better handling than the Dual Mesh®, as it promotes a rapid and easy deployment of the prosthesis inside the abdominal cavity, favoring its positioning. The use of both prosthesis depends also on the experience specific to each operator, moreover, a rigorous surgical technique remains fundamental for the application of the mesh used.

Rolipram versus imipramine in inpatients with major, "minor" or atypical depressive disorder: a double-blind double-dummy study aimed at testing a novel therapeutic approach.

Unlike conventional antidepressants, rolipram stimulates both the presynaptic as well as the postsynaptic component of monoaminergic transmission. Several double-blind comparative trials are on the way to assess the clinical efficacy and safety of this novel compound. The present study was a randomized double-blind double-dummy comparison with imipramine in inpatients with major, "minor" and atypical depressions (DSM III). Results show no relevant differences between rolipram and imipramine regarding efficacy and safety.

[Thrombolytic therapy in the treatment of thromboembolism of the right cardiac cavity during pulmonary embolism: our experience with rt-PA and review of the literature]. / La terapia trombolitica nel trattamento dei tromboemboli nelle cavità cardiache destre in corso di embolia polmonare: nostra esperienza con l'rt-PA e revisione della letteratura.

In 4 consecutive patients admitted for multiple pulmonary embolism 2-dimensional echocardiography showed large right atrial migrant thromboemboli in transit, floating and prolapsing into the right ventricle in diastole. This pattern was always associated with the echocardiographic signs of pulmonary hypertension. All the patients were treated with intravenous infusion of 100 mg of rt-PA in 3 hours. rt-PA determined the dissolution and disappearance of the right atrial thromboemboli (it took 4 hours in 2 patients and 5 hours in the remaining 2), and the concomitant disappearance of the echocardiographic signs of pulmonary hypertension. During and after the rt-PA therapy there was no evidence of further pulmonary embolism. The fibrinolytic treatment for right atrial thromboemboli during multiple pulmonary embolism is a promising alternative to right atrial thrombectomy: our results indicate that rt-PA acts rapidly and is effective and safe; if these results will be confirmed in a larger group of patients, rt-PA could become the first-choice therapy of right atrial thromboembolus.

[ST segment depression in precordial leads in patients with inferior acute myocardial infarction: the role of right ventricular involvement]. / Sottoslivellamento anteriore del tratto ST in pazienti con infarto miocardico inferiore acuto: influenza del coinvolgimento ventricolare destro.

The aim of the present study was to evaluate the influence of right ventricular involvement on the magnitude of precordial ST segment depression during inferior acute myocardial infarction. For this reason 61 patients (55 M, 6 F; mean age 53 years--range 38-73 years) admitted in our CCU for inferior acute myocardial infarction were studied by coronary angiography within 3-5 days from the onset of symptoms. The angiography showed either occlusion or critical coronary stenosis ranging as follows: on right coronary artery proximal (Group 1) to the first branch for right ventricle in 22 patients, on right coronary artery distal to the first branch for right ventricle in 25 patients (Group 2) and on circumflex artery (Group 3) in 14 patients. No difference in LAD disease were noted between the 3 groups. Using myocardial scintigraphy (Tc-99m- pyrophosphate) we confirmed the presence or the absence of right ventricular involvement in the 3 groups. In the 3 groups the magnitude of ST segment depression in V2, selected as representative left-sided precordial lead, ranged as follows: Group 1: -0.25 +/- 1.34 mm; Group 2: -1.64 +/- 1.80 mm; Group 3: -2.00 +/- 1.97 mm. In patients with right ventricular involvement (Group 1) there was a statistically significant reduction of precordial ST segment depression either in comparison to Group 2 (p less than 0.01) or to Group 3 (p less than 0.005) but none between Group 3 and 2. (ABSTRACT TRUNCATED AT 250 WORDS)